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The Elusive Liver

 

Your Lupus, Your Body: The Elusive Liver

Does the health and well-being of your liver pop into your mind when you’re not feeling well?
Chances are, probably not. The liver isn’t exactly the first thing you think of when considering
lupus and its many symptoms and potential complications. The liver is mysterious; we know it’s
there (though maybe not always exactly where “there” is) and we know it’s vital to life but that’s
probably about it. This is a great time to learn more about this elusive organ, its functions,
conditions, and what you can do should a liver complication present itself.

Function of the Liver

The darkish-red liver is on the right side of your body, under the diaphragm, on top of the
stomach, kidney, and intestines. Its two lobes and eight segments are host to thousands of lobules
which, connect ducts to larger ducts that eventually forms the hepatic duct. The hepatic duct is
responsible for transporting bile produced by liver cells to the gallbladder and duodenum.

The liver is responsible for:

  • Excreting bile which breaks down fats and prepares them for digestion and absorption.
  • The balance and creation of nutrients for the body to use.
  • The metabolism of drugs and clearing of harmful substances from the blood.
  • Production of proteins for blood plasma.
  • Production of cholesterol and proteins that carry fat through the body.
  • Storage and release of glucose.
  • Processing hemoglobin for iron storage.
  • The conversion of harmful ammonia into urea which is excreted in urine.
  • Regulating blood clotting.
  • Producing immune factors and removing bacteria from the bloodstream.
  • Clearing out bilirubin which can turn the skin and eyes yellow if there is too much of it in the system.

 Conditions of the Liver, Diagnostics, Treatment

While liver test abnormalities are typically common for individuals with lupus due to medication
side effects (which is why you receive routine blood tests while on medication to test for any
drug implications), individuals with lupus typically do not suffer from adverse liver conditions.
However, if active inflammation of the liver does occur, several medical conditions may be the
culprits. Just like with anything else, knowledge is key, and it’s good to have a general
understanding of these conditions should you or someone you know experience new symptoms
or receive a diagnosis or treatment options.

 

Lupus Hepatitis

“Hepatitis” simply means inflammation of the liver. Inflammation of the liver can also occur
from medication, viral hepatitis B and C, alcohol, and genetic disorders. If an individual with
lupus is tested for a liver disorder and the testing comes out negative for any of the
aforementioned causes yet inflammation still exists, the inflammation may be due to lupus
hepatitis; the body sees its own liver as a foreign object and attacks it. Lupus hepatitis occurs in
roughly 5% of individuals with lupus and is more common in children than adults. A liver biopsy
can determine if an individual is experiencing lupus hepatitis. Typically, the inflammation is
mild, resulting in no significant problems or discomfort. Sometimes, however, inflammation can
be more pervasive and include fatigue, loss of appetite, pain, fluid in the abdomen, jaundice, and
even cirrhosis. Cirrhosis symptoms can include fatigue, easy bleeding and bruising, jaundice,
swelling of the legs, redness in the palms of hands, and spider like vessels appearing on the skin.
Cirrhosis can cause irreversible damage and scarring to the liver, but it’s very rare in lupus
hepatitis.

Treatment includes corticosteroids and/or immunosuppressant medications.

Small Vessel and Hepatic Vasculitis

Vasculitis is the inflammation and damage of the blood vessels or blood vessel walls. Depending
on what organ the vasculitis may affect determines the type of vasculitis which is occurring.
When vasculitis affects the liver, the condition is considered small vessel vasculitis because it
affects the capillaries and smaller vessels of the liver. While the cause of vasculitis is relatively
unknown, autoimmune disorders are thought to be one of the underlying causes of these vascular
disorders. Biopsies, blood test, x-rays, urinalysis, and even angiograms may determine the onset
of the disorder.

Though rare, hepatic vasculitis may also occur when the arteries (the large blood vessels) of the
liver become inflamed. Liver enzyme levels may increase as well as the occurrence of abdominal
discomfort.

Treatment includes corticosteroids and/or immunosuppressant medications.

Antiphospholipid Syndrome

Though rare and primarily affecting young women when it does occur, antiphospholipid
syndrome is an autoimmune disorder which arises when abnormal proteins called antiphospholipid autoantibodies are present in the blood. This causes improper blood flow and dangerous clotting that may occur in the veins and arteries. This can even result in miscarriage during pregnancy. Most commonly, this complication occurs when the blood of the large veins that drain blood from the liver clots, resulting in the condition doctors call Budd-Chiari syndrome.

Budd-Chiari typically occurs when a clot blocks or narrows the hepatic veins. The liver enlarges,
and the spleen may as well, with a backup of fluid and blood. This increased pressure (called
portal hypertension) along with an enlarged and potentially damaged liver, may lead to fluid
accumulation in the abdomen. The kidneys may also contribute to this condition, as they will
retain salt and water.

Individuals who have Budd-Chiari may experience fatigue, edema (swelling), and/or abdominal
pain. Diagnosing this condition includes blood tests, magnetic resonance imaging of blood
vessels, CT scans, Doppler ultrasonography, and/or liver biopsy.

Treatment includes fibrinolytic (thrombolytic) drugs, anticoagulant/blood thinning drugs,
angioplasty, stent insertion, and/or a procedure called, a transjugular intrahepatic portal-system
shunting (to bypass blood flow away from the liver). This last one involves no scars, but
requires a radiologist to approach the liver from the jugular vein of the neck.

 

Keeping Healthy

While it may seem easy to ignore or dismiss symptoms especially when you may be
experiencing many, you may only cause yourself greater distress in the long-run. Know your
body and know when it just doesn’t feel right or when your normal feels different or off,
especially if a symptom seems new or idiosyncratic. An appointment with your doctor may bring
answers and peace and you will feel more in control of your health by taking charge of yourself.

  • Always avoid smoking, vaping, etc. It only serves to increase the possibility for health complications that may be avoidable for not only yourself, but those around you as well.
  • Avoid heavy consumption of alcohol. Toasting in the new year or your birthday is fine (as long as you don’t have underlying issues with alcohol), but consuming more than a fair share on a daily basis or attending one-to-many happy hours every week can be detrimental to your health and well-being.
  • Eat your greens…and reds…and oranges…and blues. A diet high in antioxidants, fiber, vitamins, and nutrients assures you that you are doing something good for yourself. It’s okay to treat yourself occasionally to a piece of cake or ice cream sundae, but the scale should always tip in favor of your leafy greens, sumptuous blueberries, and crunchy carrots. Remember to drink plenty of water!
  • Maintain a healthy weight and get up and move when you can. You probably experience the good days with the not-so-good days, but on the days you are feeling more able, be sure to take a walk, do some yoga or tai chi, if you can swim enjoy exercising in a pool, or even just stretch. Movement, combined with a healthy diet, will help you maintain a healthy weight which will stave off other health complications and enable you to feel good about yourself.
  • Live as stress-free a life as possible (we know; easier said than done). Engage in activities that bring you peace such as a hobby you love (reading, crafting, painting) or as your time and health allows, volunteer for a cause you are passionate about and love to support. Enjoy time with friends and family; laugh at your dad’s silly jokes, go on a date night with your partner, celebrate a friend’s new job, play Minecraft with the kids. Some hospitals offer health and wellness classes such as stress management; take advantages of these wonderful opportunities to disengage with the frenetic outside world and enjoy what and who you love!

In Conclusion

You are your best advocate when you’re not feeling well. No one knows your body like you do
and how you are feeling day-to-day. Paying attention to the nuances of your symptoms and
gaining a healthy knowledge of what complications may occur is your first defense to remaining
healthy. Your lupus and the myriad of symptoms that you may or may not experience need not
remain elusive. Doing a little investigative work to unravel the mystery of your body, its
systems, and its organs like the liver will take the guesswork out of knowing when to seek
medical attention to help ensure the best possible outcome and remain at your best.
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References

Beisel, C., Lohse A., Teufel, A., & Weiler-Normann, C. (2014) Association of autoimmune
hepatitis and systemic lupus erythematodes: A case series and review of the literature.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168105/
Lahita, R. G., &  Phillips, R.H. (2014). Lupus: Everything you need to know (3rd ed.).  Garden
City Park, NY: Avery Pub. Group.
Mayo Clinic Staff (2018). Cirrhosis. Retrieved from  https://www.mayoclinic.org/diseases-
conditions/cirrhosis/symptoms-causes/syc-20351487
Nabili, S. (2018). Vasculitis. Retrieved
from  https://www.emedicinehealth.com/vasculitis/article_em.htm#what_is_the_prognosis_for_v
asculitis
Orfanidis, N. T. (2018). Budd-chiari syndrome. Retrieved
from  https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/blood-vessel-
disorders-of-the-liver/budd-chiari-syndrome
Stanford Children’s Health (2018). Anatomy and function of the liver. Retrieved from:
https://www.stanfordchildrens.org/en/topic/default?id=anatomy-and-function-of-the-liver-
90-P03069
Thomas, D. E. (2014). The lupus encyclopedia: A comprehensive guide for patients and
families. Baltimore, MD: Johns Hopkins University Press.
Weselman, K. (2017). Antiphospholipid syndrome. Retrieved from
https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-
Conditions/Antiphospholipid-Syndrome

Article by Liz Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Marylhurst, Oregon. She most recently worked for several years in the healthcare industry. A native of San Fransisco, California, Liz now calls the beautiful Pacific Northwest home.

 

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vetted as a relevant resource. We encourage you to be your strongest advocate and always
contact your medical provider with any specific questions or concerns.

Article by : Kaleidoscope Fighting Lupus